Download PBL Stroke 2010

Investigations
Aims to:
1. Confirm the vascular nature of the lesion
2. Distinguish cerebral infarction from haemorrhage
3. Identify the underlying vascular disease and risk factors
An early and accurate diagnosis is based on medical history, physical examination, laboratory
examination as well as imaging methods, like computed tomography of the brain.(Hippokratia)
Investigation of a patient with an acute stroke ( improvised from Davidson)
Other tests:
1. Liver function test ( baseline test)
2. Cardiac enzymes
3. Urea and electrolytes
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Urinalysis
Blood culture
Syphilis serology
Chest X ray
Serum protein electrophoresis
Autoantibody screen (for anticardiolipin antibody, antinuclear antibody, antineutrophil
cytoplasm antibody)
10. Protein C,S and antithrombin III levels, Factor VIII; activated Protein C resistance (Factor V Leiden)
11. Cerebral angiography (detect cerebral vasculitis)
Imaging the brain
CT
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Most practical and widely available method of imaging the brain
Able to exclude non-stroke lesions (subdural haematomas, brain tumours)
Able to pick up intracerebral haemorrhage within minutes of stroke onset
CT changes in cerebral infarction may be completely absent or very subtle within the first few
hours after symptom onset, though changes usually evolve over time. However, abnormal
perfusion of brain tissue can be imaged with CT after injection of contrast media (perfusion
scanning)
MRI
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Not as widely available as CT, longer scanning times
MRI diffusion weighted imaging (DWI) can detect ischaemia earlier than CT
References
1. Davidson’s Principles & Practice of Medicine. 20th ed
2. Hippokratia. 2008 Apr–Jun; 12(2): 98–102
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464301/)